Chaix Basile, Leyland Alastair H, Sabel Clive E, Chauvin Pierre, Råstam Lennart, Kristersson Håkan, Merlo Juan
Community Medicine and Public Health, Department of Clinical Sciences, Malmö University Hospital, S-205 02 Malmö, Sweden.
J Epidemiol Community Health. 2006 May;60(5):427-35. doi: 10.1136/jech.2005.040360.
Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects.
Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders.
All 89,285 persons aged 40-69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence.
The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale.
Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders.
以往研究为精神障碍的空间差异以及邻里社会环境与心理健康之间的关联提供了初步证据。本研究通过以下方式扩展了以往的文献：（1）使用空间技术而非多水平模型来比较两组精神障碍（即精神活性物质所致障碍以及神经症性、应激相关和躯体形式障碍）的空间分布；（2）调查背景剥夺和邻里社会无序对心理健康的独立影响，同时评估这些影响的程度和空间尺度。
该研究使用不同的空间技术，调查了精神活性物质所致精神障碍和神经症性障碍。
2001年居住在瑞典马尔默的所有89285名年龄在40至69岁之间的人，其地理位置定位到他们的居住地。
空间扫描统计发现，在马尔默北部的一个相似位置，这两种精神障碍的患病率都有一个大的聚集区。然而，分层地质统计模型显示，这两组障碍在程度和空间尺度方面都呈现出不同的空间分布。与神经症性障碍相比，物质使用所致精神障碍在邻里间的差异更大，且在空间上的变化范围更广。在对个体因素进行调整后，与物质相关障碍的风险随着邻里剥夺和邻里社会无序而增加。神经症性障碍的风险仅随着背景剥夺而增加。在连续空间中测量背景因素时，发现这些关联在局部尺度上起作用。
在分析中考虑空间因素有助于更深入地了解精神障碍的背景决定因素。
